Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.

Thomas P Hellyer; Andrew Conway Morris; Daniel F McAuley; Timothy S Walsh; Niall H Anderson; Suveer Singh; Paul Dark; Alistair I Roy; Simon V Baudouin; Stephen E Wright; Gavin D Perkins; Kallirroi Kefala; Melinda Jeffels; Ronan McMullan; Cecilia M O'Kane; Craig Spencer; Shondipon Laha; Nicole Robin; Savita Gossain; Kate Gould; Marie-Hélène Ruchaud-Sparagano; Jonathan Scott; Emma M Browne; James G MacFarlane; Sarah Wiscombe; John D Widdrington; Ian Dimmick; Ian F Laurenson; Frans Nauwelaers; A John Simpson

doi:10.1136/thoraxjnl-2014-205766

Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.

Thomas P Hellyer, Andrew Conway Morris, Daniel F McAuley, Timothy S Walsh, Niall H Anderson, Suveer Singh, Paul Dark, Alistair I Roy, Simon V Baudouin, Stephen E Wright, Gavin D Perkins, Kallirroi Kefala, Melinda Jeffels, Ronan McMullan, Cecilia M O'Kane, Craig Spencer, Shondipon Laha, Nicole Robin, Savita Gossain, Kate GouldMarie-Hélène Ruchaud-Sparagano, Jonathan Scott, Emma M Browne, James G MacFarlane, Sarah Wiscombe, John D Widdrington, Ian Dimmick, Ian F Laurenson, Frans Nauwelaers, A John Simpson

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare. OBJECTIVES: We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP. METHODS: A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination. RESULTS: Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p

Original language	English
Pages (from-to)	41-47
Journal	Thorax
Volume	70
DOIs	https://doi.org/10.1136/thoraxjnl-2014-205766
Publication status	Published - 8 Oct 2014

Keywords

Pneumonia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/thoraxjnl-2014-205766

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Hellyer, T. P., Conway Morris, A., McAuley, D. F., Walsh, T. S., Anderson, N. H., Singh, S., Dark, P., Roy, A. I., Baudouin, S. V., Wright, S. E., Perkins, G. D., Kefala, K., Jeffels, M., McMullan, R., O'Kane, C. M., Spencer, C., Laha, S., Robin, N., Gossain, S., ... Simpson, A. J. (2014). Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia. Thorax, 70, 41-47. https://doi.org/10.1136/thoraxjnl-2014-205766

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title = "Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.",

abstract = "BACKGROUND: Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare. OBJECTIVES: We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP. METHODS: A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination. RESULTS: Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p",

keywords = "Pneumonia",

author = "Hellyer, {Thomas P} and {Conway Morris}, Andrew and McAuley, {Daniel F} and Walsh, {Timothy S} and Anderson, {Niall H} and Suveer Singh and Paul Dark and Roy, {Alistair I} and Baudouin, {Simon V} and Wright, {Stephen E} and Perkins, {Gavin D} and Kallirroi Kefala and Melinda Jeffels and Ronan McMullan and O'Kane, {Cecilia M} and Craig Spencer and Shondipon Laha and Nicole Robin and Savita Gossain and Kate Gould and Marie-H{\'e}l{\`e}ne Ruchaud-Sparagano and Jonathan Scott and Browne, {Emma M} and MacFarlane, {James G} and Sarah Wiscombe and Widdrington, {John D} and Ian Dimmick and Laurenson, {Ian F} and Frans Nauwelaers and Simpson, {A John}",

year = "2014",

month = oct,

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doi = "10.1136/thoraxjnl-2014-205766",

language = "English",

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Hellyer, TP, Conway Morris, A, McAuley, DF, Walsh, TS, Anderson, NH, Singh, S, Dark, P, Roy, AI, Baudouin, SV, Wright, SE, Perkins, GD, Kefala, K, Jeffels, M, McMullan, R, O'Kane, CM, Spencer, C, Laha, S, Robin, N, Gossain, S, Gould, K, Ruchaud-Sparagano, M-H, Scott, J, Browne, EM, MacFarlane, JG, Wiscombe, S, Widdrington, JD, Dimmick, I, Laurenson, IF, Nauwelaers, F & Simpson, AJ 2014, 'Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.', Thorax, vol. 70, pp. 41-47. https://doi.org/10.1136/thoraxjnl-2014-205766

TY - JOUR

T1 - Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.

AU - Hellyer, Thomas P

AU - Conway Morris, Andrew

AU - McAuley, Daniel F

AU - Walsh, Timothy S

AU - Anderson, Niall H

AU - Singh, Suveer

AU - Dark, Paul

AU - Roy, Alistair I

AU - Baudouin, Simon V

AU - Wright, Stephen E

AU - Perkins, Gavin D

AU - Kefala, Kallirroi

AU - Jeffels, Melinda

AU - McMullan, Ronan

AU - O'Kane, Cecilia M

AU - Spencer, Craig

AU - Laha, Shondipon

AU - Robin, Nicole

AU - Gossain, Savita

AU - Gould, Kate

AU - Ruchaud-Sparagano, Marie-Hélène

AU - Scott, Jonathan

AU - Browne, Emma M

AU - MacFarlane, James G

AU - Wiscombe, Sarah

AU - Widdrington, John D

AU - Dimmick, Ian

AU - Laurenson, Ian F

AU - Nauwelaers, Frans

AU - Simpson, A John

PY - 2014/10/8

Y1 - 2014/10/8

N2 - BACKGROUND: Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare. OBJECTIVES: We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP. METHODS: A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination. RESULTS: Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p

AB - BACKGROUND: Excessive use of empirical antibiotics is common in critically ill patients. Rapid biomarker-based exclusion of infection may improve antibiotic stewardship in ventilator-acquired pneumonia (VAP). However, successful validation of the usefulness of potential markers in this setting is exceptionally rare. OBJECTIVES: We sought to validate the capacity for specific host inflammatory mediators to exclude pneumonia in patients with suspected VAP. METHODS: A prospective, multicentre, validation study of patients with suspected VAP was conducted in 12 intensive care units. VAP was confirmed following bronchoscopy by culture of a potential pathogen in bronchoalveolar lavage fluid (BALF) at >10(4) colony forming units per millilitre (cfu/mL). Interleukin-1 beta (IL-1β), IL-8, matrix metalloproteinase-8 (MMP-8), MMP-9 and human neutrophil elastase (HNE) were quantified in BALF. Diagnostic utility was determined for biomarkers individually and in combination. RESULTS: Paired BALF culture and biomarker results were available for 150 patients. 53 patients (35%) had VAP and 97 (65%) patients formed the non-VAP group. All biomarkers were significantly higher in the VAP group (p

KW - Pneumonia

U2 - 10.1136/thoraxjnl-2014-205766

DO - 10.1136/thoraxjnl-2014-205766

M3 - Article

C2 - 25298325

SN - 1468-3296

VL - 70

SP - 41

EP - 47

JO - Thorax

JF - Thorax

ER -

Diagnostic accuracy of pulmonary host inflammatory mediators in the exclusion of ventilator-acquired pneumonia.

Abstract

Keywords

UN SDGs

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